The Department of Veterans Affairs commissioned a study that looked at bile duct cancer and liver flukes that may have been ingested by veterans while on tour in Southeast Asia during the Vietnam War.

This was in response to a story reported by the Associated Press in which 700 cases, of cholangiocarcinoma, bile duct cancer, were seen in VA facilities over the last 15 years.

The current small study looked at 50 blood samples, finding 20% of which to be positive for liver flukes. Most participants were not aware they were infected. If infection did later lead to cancer, symptoms would come late in the diagnosis.

Tropical medicine specialist, Sung-Tae Hong, from Seoul National University in South Korea, stated he was “surprised” by the results and admits to more research needing to be done.

Cholangiocarcinoma is still rare, however if Vietnam veterans are at increased risk due to their fish consumption while on duty, they need to be followed closely by their medical provider. Stool tests could be done to look for parasite eggs, and blood tests may look for antibodies fighting the infection.

What is a liver fluke?

Liver flukes are parasites that infect the liver and bile duct. There are multiple species. The disease Fasciola hepatica and Fasciola gigantica cause is called fascioliasis. Symptoms may range from none to severe liver disease. But the liver flukes associated with bile duct cancer include Opisthorchis viverrini, O. felineus, and Clonorchis sinensis. According to the US Department of Veterans Affairs:

The irritation and scarring caused by liver fluke infection can lead to bile duct cancer.

Two parasites are commonly involved. One is Opisthorchis verrini, which is found in Southeast Asian countries, including Thailand, Lao People’s Democratic Republic, Vietnam, and Cambodia. The other is Clonorchis sinensis, which is common in rural areas of Korea and China.

Eating raw or undercooked fish infected with these parasites introduces the pathogen into the GI system where it can hide out in the liver and bile ducts for decades.

In 2007, Sripa et al discussed how close to 600 million people were at risk of being infected with liver flukes.

In 2011, Lim et al wrote, “More than 35 million people worldwide are infected. The exceptionally high incidence of cholangiocarcinoma in Thailand and Korea is attributed to the high prevalence of liver fluke infection in these areas.”

How does one get contract liver flukes?

In addition to ingesting undercooked contaminated fish, liver flukes can infect multiple mammals, such that eating infected cattle or sheep liver (if undercooked) could transmit the parasite. Ingesting vegetables washed with contaminated water could introduce the fluke into a person as well.

Medical News Today recommends boiling all untreated water and to avoid water from a stream near where cattle and sheep live.

What are the symptoms of infection with liver flukes?

Although some people with liver flukes may exhibit no symptoms at all, some may incur:

Fatigue

Abdominal Pain

Fever

Nausea

Vomiting

Diarrhea

Jaundice – yellowing of the skin and whites of eyes

Itchy skin

Weight loss

What is the prognosis of cholangiocarcinoma (bile duct cancer)?

According to cancer.net, the 5 year survival, meaning living 5 years past diagnosis, is 30%, assuming the cancer stays locally. If the cancer spreads to regional lymph nodes prognosis for 5 year survival drops to 24%. Distant spread of the cancer reduces the 5 year survival rate to 2%.

What is the treatment for liver flukes?

Anti-Parasitic medications, such as triclabendazole, have proven effective against Fasciola. Praziquantel has been effective in fighting Opisthorchis infections.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD, FAAFP and a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Thanksgiving (and the in-laws) has come and gone. And now we have lots of leftovers. And lots of pets. Can pets eat Thanksgiving table scraps and leftovers?

Let’s look at what they can and cannot eat.

Dogs

According to the American Kennel Club, dogs can eat the following (in moderate amounts):

Turkey, Chicken, Beef (remove all bones so they don’t get swallowed and perforate the gut)

Ham

Shrimp

Salmon

Eggs

Cheese

Peanut Butter

Bread (without raisins)

Popcorn

Corn

Honey

Coconut

Avoid the following in dogs:

May be toxic; cause nausea, vomiting and diarrhea; kidney damage; pancreatitis due to high fat content, or intestinal obstruction.

Onions

Garlic

Avocado

Raisins

Grapes

Chocolate

Cinnamon

Ice cream

Almonds

Macadamia nuts

Alcohol

Nutmeg

Mushrooms

Energy drinks

Fatty/fried foods

In addition to my dog Apollo, I have 4 cats. So they’re begging for Thanksgiving leftovers as well.

Cats

Fluffy can eat – but again only in moderation:

Meat

Fish

Grains

Vegetables (though many stick their nose up at it)

Eggs

Cheese

Butter

Avoid similar foods as with dogs due to toxicity and also (according to Vetsnow)

Alcohol

Artificial Sweeteners

Raw fish and eggs

Coffee, tea and energy drinks

Fish

Yes, even Nemo can join in for Thanksgiving leftovers.

It appears fish can eat many types of meat and vegetables and even cooked rice but be careful of toxins and cooking oils.

Parakeet

I don’t have any of these and if I did, I doubt I’d share my turkey with it. But according to pethelpful.com, many fruits, vegetables, breads and nuts (chopped up without shell) can be eaten by birdie.

I hope everyone had a healthy and wonderful Thanksgiving!!!

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD, FAAFP and a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Thanksgiving is here!! Good food, no school, no work, and most of all….. family!!

For many this is one of the best holidays ever!!

For some…..the most dreaded all year.

This is your very rare and valuable time off, and you have to spend all of it with people who don’t like you and you’re not particularly fond of. Four days of staying with family, (especially if they don’t let you stay a hotel and insist you stay with them), can be more than many can bear.

So here are some steps you can take to make the holidays easier.

1. Huddle up

Usually your spouse wants to avoid controversy just as much as you do. Before the encounter, huddle up and create a strategy for:

a. How to deal with insults

b. How to take a break – take the car to go grab some last-minute Thanksgiving necessities

c. Where you get to sit at the table

d. Potential arguments regarding the children and their upbringing

2. Try to get a hotel room

This gives you the much-needed reprieve at the end of the day. However, if the family insists you stay with them and 4 nights at Hotel Hell are just too much to bear, plan a “sneak away” for an evening with your wife and tell the Grandparents they will host the kid’s slumber party. Remember to thank them for the huge favor they are doing allowing you and the wife a much needed night away “from the kids” …wink…wink…..

3. Football

Thank Heavens the Cowboys are playing this Thanksgiving. Usually there is someone else in the family just as sane as you are when it comes to football, so you can immediately partner with him to get the television on and the game playing. Although this may only give you a 15 minute “out” of the family festivities, it’s 15 minutes of pure euphoria.

4. Remember you have sciatica

The most difficult part of Thanksgiving/Christmas is sitting at a table for hours and usually trapped, physically, because the chairs are pushed together so tight that you can’t push out the chair. If you ever, ever, ever had an issue with your back, knee, leg, muscle, or even pinky toe, use this as an excuse to heave the table forward so you can get up and stretch your legs. Slowly limp over to the living room where hopefully you left the football game on……

5. Get called to work

No in-law can or wants to take on your boss. So during the 7 day stent, politely excuse yourself if you need to go onto a computer, make a phone call, or drive 60 miles away for “work”. Make sure your spouse is on board with this one……

6. Have “diarrhea”

You get to leave the room and no one wants to be near you. You just gained escaping 3-5 times/hour since you need to “run” to the bathroom.

7. Inform the family you feel a cold coming on

Don’t jinx yourself but this gets you out of hugs, and sloppy lipstick kisses…..

Ok this gives you a well-coordinated exit plan but what happens if they are on to you? How do you deal with the remaining, 3 days, 23 hours and 45 minutes?

1. Don’t take it personally

When the insults and digs come, don’t feel like these personal attacks need to stick. You have enough people in your life telling you your shortcomings. The in-laws are either being redundant or telling you something that doesn’t hold true.

2. You’re not alone

Millions of adults are in the exact same position as you at the same moment in time. You’re not alone. Just sneak a peek on facebook and you’ll scroll through hundreds of “Ugh!!!!”s………..

3. Make a game of it

Bet your wife or coworker that you will get the most insults over the holiday than they will and write down or note every time it happens. The more it occurs, you win. Compare notes or use it as a “get out jail free card” with your spouse.

4. Have a happy place

Negotiate with your spouse prior to the holiday a “free day” or “free weekend” that you will earn upon completion of a 7 day holiday with the in-laws. Plan and fantasize about this reward throughout your tour of duty to make the path easier

5. Bring the pets

Since you are usually outnumbered during these family events, why not have non humans come to your aid. Dogs need to be walked, cats need to be chased, so this gives you an out and gives you a much-needed buddy during the hard times.

Look, it’s not easy, but remember why you’re there. For YOUR family. Your spouse and kids need to spend the holidays with you so grin and bear it. And remember you may be luckier than the average guy. He could be spending the WHOLE WEEK! Ahhh, you DO have something to be thankful for.

Happy Thanksgiving!!!!

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD, FAAFP and a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

The 76-year-old two-time Democratic presidential candidate stated he and his family noticed changes three years ago and, “after a battery of tests, my physicians identified the issue as Parkinson’s disease, a disease that bested my father.”

His father, Noah L. Robinson, died in 1997 at the age of 88 of a heart attack and complications of Parkinson’s.

What is Parkinson’s Disease?

Parkinson’s disease is the second most common neurodegenerative disorder, next to Alzheimer’s, and the most common movement disorder that affects 1% of the world’s population over 60 years old. In the US, 60,000 new cases are diagnosed each year. It affects several areas of the brain, primarily the substantia nigra, altering balance and movement by affecting dopamine producing cells.

Image from the Science of Parkinson’s Disease

It was first described in 1817 by James Parkinson as a “shaking palsy.”

What are the Symptoms of Parkinson’s?

Common symptoms of Parkinson’s include:

Stiffness and rigidity

Poor balance

Tremor at rest, especially a pill-rolling tremor

Slow movement

Inability to move

Shuffling steps, gait

and patients may later develop…

Depression

Anxiety

Memory loss

Constipation

Decrease ability to smell

Difficulty swallowing

Erectile dysfunction

Pneumonia

Fractures from falling

Hallucinations

Delusions

Dementia

Who is at Risk for Parkinson’s?

Most cases are idiopathic, meaning the disease arises with no specific cause. However some cases are genetic and multiple genes have been identified that are associated with the disease.

The average age of onset is 60, but some cases may occur as “early onset”, before the age of 50, and if before the age of 20, it is known as juvenile-onset Parkinson’s.

Men appear to be more affected than women at twice the rate.

Risk may be enhanced with a history of head trauma.

Exposure to herbicides and pesticides has been linked to an increased risk of Parkinson’s as well.

How Quickly do Parkinson’s Symptoms Progress?

Average progression rates can last years to decades, however, earlier onset disease may manifest much quicker.

The stages of Parkinson’s are illustrated below:

How is Parkinson’s treated?

Although there is no cure for Parkinson’s, symptoms can be treated by a variety of measures.

Levodopa – converts to dopamine in the brain, helping replace the deficient hormone.

Carbidopa (Sinemet) – if given with levodopa prevents the latter from being broken down before it reaches the brain.

Other medications including COMT inhibitors, amantadine and anticholinergics

Medications to treat anxiety and depression

Deep brain stimulation – a surgeon implants electrodes into the brain, allowing stimulation of parts that help regulate movement.

Stem cell therapy – being investigated as a means to create dopamine-producing cells

Physical and occupational therapy

Famous People Diagnosed with Parkinson’s

Michael J. Fox

Janet Reno

Robin Williams

Muhammad Ali

Casey Kasem

Johnny Cash

Linda Ronstadt

Pope John Paul II

Peanuts creator Charles Schulz

It’s been postulated Adolf Hitler suffered from Parkinson’s as well.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD, FAAFP and a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

The report released Monday revealed the 41 year old pro-golfer had the following in his system when he was found asleep in his car on the side of the road while the lights were on and turning signal was flashing: Ambien, Xanax, Dilaudid, Vicodin and Delta-9 carboxy THC (tetrahydrocannabinol).

Woods had undergone spinal fusion surgery weeks prior.

Vicodin is a narcotic made of hydrocodone and acetaminophen. It is used for pain and most commonly prescribed post-operatively.

Dilaudid is hydromorphone, a stronger narcotic.

Xanax is a benzodiazepine used for sedation, relaxation and to lower anxiety.

Ambien is a hypnotic type of sedative used for sleep and works within 15 minutes of ingestion.

Delta-9 carboxy THC (tetrahydrocannabinol) is the psychoactive ingredient in marijuana.

None of these medications are to be used while driving. Additionally none should ever be used in combination. The respiratory depression of one narcotic combined with the sedative effect of the benzodiazepine or hypnotic could cause death.

Woods entered a plea of not guilty to DUI, as alcohol was not involved and a mixture of medications was to blame, but it's been reported a deal was made among prosecutors including a lesser charge of reckless driving and a stint in a “diversion program.”

Last month Woods stated he completed a private intensive program on his own. On Monday he stated, “Recently, I had been trying on my own to treat my back pain and a sleep disorder, including insomnia, but I realize now it was a mistake to do this without medical assistance.”

Polypharmacy, or taking multiple medications at the same time, can increase the risk of serious adverse events if the drugs act synergistically or mask side effects of one another.

Many overdoses occurring with pain pills may not always be a quantity issue with the narcotic but rather a mixture of the narcotic with another medication such as those taken by Tiger Woods. He was lucky to still be alive when found as were those pedestrians or drivers on the street that evening.

Fast food has become the staple of many American and European diets and we’ve seen obesity rise. True more people take public or private transportation to work over walking, and many have given up smoking every time they had a hunger itch, but the most popular reason for our waistline increase is fast food. But is it the caloric content of the fast food that’s fueling the obesity epidemic, or the speed at which its ingested?

What is Fast Food?

According to the Merriam-Webster dictionary, Fast Food is “food that can be prepared and served quickly”. A burger, shake and fries is considered fast food but so is a take away salad or sandwich. It’s implied that fast food is a meal that is not made fresh but made previously and preserved such that it can taste fresh when needed to be served.

How Caloric is Fast Food?

According to CalorieKing, a McDonald’s Big Mac is 540 calories. A large order of fries is 510 calories. So a meal over 1000 calories is obviously not the healthiest choice.

Now on the same site a Tuna Salad Sandwich (5 oz) w. mayo, 3 oz Bread is 679 calories.

So are we becoming obese eating cobb salads and tuna salad for lunch just as one would eat a Big Mac? We don’t know since people don’t study cobb and tuna salad eating consumers. My guess is no.

Are we eating too fast?

Yes, and so fast that I believe it could be messing with our metabolism.

Think back to caveman days. We had to chew. And not on a soft sesame seed bun, but chew our meat. Nuts and vegetables took a chewing as well. Food was more scarce so it was savored and meals weren’t on the run while on a subway or at a stop light in one’s car.

Previous studies have shown that eating slowly and chewing it multiple times allow the body’s signals to trigger the satiety sensation sooner, hence one would eat less.

So gulping down a burger in 5 bites could be accomplished prior to the brain receiving the signal that it should be satisfied.

Now the metabolism issue. Fast food could contain sugars, fats and preservatives that alter metabolism. But eating on the run could cause metabolism issues in and of itself.

When a body senses that the food source is short-lived, unpredictable, and coming at a speed preventing proper absorption of nutrients, it may slow down metabolism to allow the body to make the most of what it has. Eating a meal slow and methodical may be the most successful way to not only feel full but to eat less and lose weight.

I suggest a study be done looking at two groups of people eating the same food with the same caloric content but differing on the speed at which they eat it.

I suggest to you all to take an extra 15 minutes to complete your meal than what you’re accustomed to and determine if you see results after a few weeks.

Of course avoiding fast food would be the most beneficial for our weight but if you must eat fast food, eat it slowly.

A study this week, reported in BBC, found men’s sperm count to drop 50% over the last 40 years. This sparked rumors that humans could eventually become “extinct”.

Researchers from Hebrew University in Jerusalem and Icahn School of Medicine in New York analyzed 42,000 male participants involved in 185 studies from the period 1973 to 2011, looking at men from North America, Australia, New Zealand and Europe and found close to a 60% drop in sperm count, although semen volume remained stable. Men from South Africa, Africa and Asia appeared to retain their sperm numbers.

So let’s break this down….

What’s in a sperm count/semen analysis?

Let’s review some anatomy. Sperm is produced in the seminiferous tubules within the testes. Once formed they travel to the epididymis, where they mature and are stored. During ejaculation, the mature sperm travel from the epididymis through the vas deferens to the ampulla, meeting with seminal fluid (produced by the seminal vesicles, prostate and bulbourethral glands) to become semen.

When a couple is having fertility issues, a semen analysis will be ordered. This looks at a variety of factors.

Volume – Sperm can’t dry up and need a medium in which to travel. Seminal fluid can amount to 1.5-5 ml (1/4-1 teaspoon). A decrease in this amount could imply issues with any of the above organs or a blockage.

Concentration – Sparse sperm in an ejaculate makes it more difficult to fertilize an egg, hence concentration of sperm should be close to 20 million sperm/ml of semen.

Motility – Sperm need to swim and compete with others, hence sluggish sperm don’t have a chance in …..well….the Fallopian tube. Close to half of the sperm analyzed should be moving.

Shape/Morphology – sperm need to be the appropriate shape to maximize success in fertilization. At least half of the sperm in each sample should be of normal shape.

Liquefaction – initial ejaculate is thick to enable an easier passage of the package of sperm. Then it needs to thin, liquefy, to allow the sperm to travel and swim. Normal liquefaction time is 15-30 minutes.

Color – semen color is usually whitish-gray but brown could signify blood, green could mean infection, yellow could signify a change due to medications, chemicals and sometimes age.

Other factors are noted such as the acidity (pH), white blood cell composition, and fructose.

What causes low sperm count

Multiple issues could account for a drop in sperm count. These include:

Hormones in our food

Endocrine disruptors in our cosmetics

Chemical exposure such as solvents, herbicides, pesticides and benzenes

Obesity

Electronics sitting on our lap

Antibodies attacking our sperm

Heavy metal exposure

Radiation

High Stress

Anabolic steroid use and some medications

Varicoceles – swelling of the veins in the testicle disrupting transport of sperm

Infection

Tumors

and the list goes on.

How to protect your sperm count

So to protect your sperm count, we recommend the following:

Keep it cool – Testicles that overheat produce less sperm, so avoid laptops or anything that could heat up the groin.

Ice used for soft drinks at leading fast food chains in the UK were found to contain bacteria usually seen in fecal matter. This comes weeks after the same BBC investigation found similar contaminated ice at Starbuck’s, Caffe Nero, and Costa Coffee.

On the TV Show Watchdog, BBC reported more than half the samples tested at food chains including Burger King, McDonald’s and Kentucky Fried Chicken (KFC) contained coliform bacteria, or bacteria that colonize intestines. Harmful bacteria, such E. coli, however was NOT found according to a spokesperson for McDonald's.

So even though the bacteria discovered would not harm humans if ingested, the potential for a dangerous pathogen exposure is there.

Samples were taken from 10 random store locations for each of the fast food chains.

Of the samples tested on McDonald’s ice machines, 3 out of 10 samples were contaminated. At Burger King, 6 out of 10 samples tested positive for coliform bacteria and at KFC, 7 out of 10 tested positive.

One theory is the cleaning of the machines and/or handling of the ice is done with direct human hand contact which could have fecal contamination from poor hand washing after bathroom use.

The contamination issues hopefully prompted chains in other countries, such as the US, to reevaluate their procedures on ice and cup handling.

Last week, when we were told Senator John McCain (R-AZ) was being treated for a blood clot above his left eye, we suspected a tumor could have been involved, as he was a cancer survivor and tumors are thrombogenic, meaning clot forming.

Unfortunately, the 80 year old melanoma cancer survivor has been diagnosed with primary glioblastoma. However, it's been reported that the whole tumor was removed when the doctors performed a craniotomy (opening of the skull) to remove the blood clot. A statement from his office reports Senator McCain is home and recovering “amazingly well.”

What is Primary Glioblastoma?

Primary Glioblastoma Multiforme is a type of brain tumor that arises in the brain and spinal cord and is very aggressive in nature. “Primary” suggests the tumor is not secondary to another cancer, such as the melanoma Senator McCain successfully battled.

In 1993, 2000 and 2002, McCain had three malignant melanoma lesions removed, and the 2000 lesion was close to his left temple.

Those diagnosed with a glioblastoma may have a poorer prognosis compared to other cancers as the 5-year survival rate is only 10%. Its median survival is less than 15 months. However, with his lesion removed, and chemotherapy and radiation set to begin once his incision has healed, many medical teams are optimistic.

According to his daughter, Meghan McCain, her father is “confident” and “calm”. CNN reports that when the Senator awoke from surgery he was “cracking jokes” and ready to go home and get to work.

While monsoon season brings shifts in temperatures, it also brings heavy winds and thunderstorms.

Yet for an asthmatic this can be exceptionally dangerous.

“Thunderstorm Asthma” is a term used when a very windy storm can induce an asthmatic attack.

Last year, nine people died in Melbourne, Australia after a thunderstorm precipitated respiratory difficulties.

The storm, it’s believed, caused pollen particles to swell and rupture into much smaller particles, which were dispersed by wind. The theory is that the immediate propulsion of much smaller (and more numerous) particles into one’s lungs was the recipe for asthma disaster.

We first learned of “thunderstorm asthma” in the 1980’s when epidemics occurred in parts of Europe, Australia and Iran. Environmental conditions change and asthma allergens meet the unsuspecting lungs.

Asthma is a respiratory condition in which inflammation causes the airways to narrow, restricting air flow and causing wheezing, shortness of breath and cough. This bronchoconstriction can be deadly if the patient doesn’t receive enough oxygen. Bronchodilators, such as albuterol are used to dilate the airways and steroids are commonly given to decrease the inflammation.

If someone has baseline asthma, a storm forecast should warrant preparatory measures, including ensuring one has plenty of inhalers, and seeing their provider to determine if they are vulnerable to “tipping over”. Many feel a false sense of security with rain as they believe it will wash away the dust. As Melbourne witnessed, a thunderstorm can be just as deadly.

A variety of factors can cause asthma attacks including:

Pollen

Smoke

Alcohol

Cold air

Dust mites

Mold

Pet dander

Exercise

Laughing

Stress

Acid reflux/heartburn

Aspirin

Air fresheners, perfume, scents

Traffic and pollution

and more.

As we see, asthma is not solely caused by a Spring time flower particle. A variety of issues can trigger an attack. If its sudden, unexpected, stressful and carries a concentrated variety of particles, this combination can be deadly. Hence “thunderstorm asthma” can be a lung’s perfect storm…….